Racial Differences in Hospice Care Outcomes in Patients With Advanced Heart Failure: Systematic Review and Meta-analysis.

There remains a paucity of investigational data about disparities in hospice services in people with non-cancer diagnoses, specifically in heart failure (HF). Black patients with advanced HF have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced HF who were enrolled in hospice services. We obtained the data from PubMed, Scopus, and Embase for all investigations published until January 11, 2023. All studies that reported race-specific outcomes after hospice enrollment in patients with advanced HF were included. Of the 1,151 articles identified, 5 studies (n = 24,899) were considered for analysis involving a sample size ranging from 179 to 11,754 patients. Black patients had an increased risk of readmission (odds ratio 1.55, 95% confidence interval [CI] 1.34 to 1.79, I2 0%) and discharge (odds ratio 1.75, 95% CI 1.53 to 1.99, I2 0%) compared with White patients. Moreover, Black patients have a nonsignificant lower risk of mortality compared with White patients (relative risk 0.67, 95% CI 0.43 to 1.05, I2 90%). In conclusion, this study showed that Black patients with advanced HF receiving hospice care have a higher risk of readmission and discharge compared with White patients.

Severe type-B lactic acidosis in a patient with bilateral renal Burkitt's lymphoma.

INTRODUCTION: Lactic acidosis (LA) can be categorized as type A, which occurs in the presence of tissue hypoxia, or type B, occurring in the absence of tissue hypoxia. Hematologic malignancies are an uncommon cause of type B LA. CASE PRESENTATION: A 63-year-old man, HIV-negative, with a history of diabetes mellitus, hypothyroidism, and non-alcoholic fatty liver disease (NAFLD), presented to the ED complaining of acute-on-chronic lumbar pain, and was found to have high serum anion gap (AG) LA. The rest of chemistry and infectious workup was within normal limits. Despite bicarbonate therapy and fluid resuscitation, the patient remained with persistent AG metabolic acidosis and increasing lactic acid up to 14.5 mmol/L. An abdominal computerized tomography (CT) revealed multiple bilateral enhancing lesions in the kidneys, as well as gastric wall thickening. Upper gastrointestinal endoscopy with biopsy showed a high-grade Burkitt's lymphoma. Further staging showed bone marrow involvement and extensive abdominal adenopathy. After two cycles of inpatient chemotherapy with dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab), the patient developed multifocal pneumonia complicated by respiratory failure. Following a prolonged ICU stay, after discussion with the family members, a decision of withdrawal of life-sustaining therapy was reached. CONCLUSION: Persistent LA, without identifiable causes of tissue hypoxia, should prompt clinicians to suspect non-hypoxic etiologies, including occult high-grade malignancies. Hematological malignancies constitute an extremely rare cause of type-B LA, carrying a poor prognosis.

Painless type A aortic dissection.

Aortic dissection is an uncommon diagnosis that typically presents with acute onset of severe pain. It rarely presents with minimal to no symptoms, which carries a higher mortality risk given the delay in diagnosis. An adequate interpretation of risk factors, clinical findings and auxiliary tests constitutes a greater value for clinicians to detect this life-threatening condition. This report describes a case of type A aortic dissection in an asymptomatic patient presenting with an abnormal electrocardiogram (ECG).

Asociación entre el conocimiento de las mujeres peruanas acerca del VIH y sus actitudes frente a personas infectadas / Association between knowledge of Peruvian women about HIV and their attitudes towards infected people

Objetivo: Determinar la asociación entre el conocimiento de las mujeres peruanas acerca del VIH con sus actitudes frente a las personas con VIH y sus características socio demográficas. Métodos: Análisis secundario de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2011. El conocimientos sobre VIH se evaluó mediante cinco preguntas: ¨se puede reducir el riesgo teniendo solo una pareja sexual?, ¨usando siempre condón?, ¨una persona saludable puede tener VIH?, ¨se puede contraer el VIH por besos y abrazos?, ¨por utensilios? Se consideró conocimiento adecuado si se contestó correctamente las cinco preguntas (directrices para el Desarrollo de Indicadores Básicos para el seguimiento de la Declaración Política sobre VIH/SIDA). La actitudes frente a personas infectadas se evaluaron mediante seis preguntas: si niño(a) tiene infección por VIH, ¨se le debe permitir asistir a la escuela o colegio? si un médico tiene infección por VIH, ¨se le debe permitir que siga con su trabajo en el establecimiento de salud? si una persona tiene infección por VIH y necesita operarse, ¨deben permitirle la operación?; ¨compraría vegetales de un vendedor con SIDA?; si un profesor tiene infección por VIH, ¨se le debe permitir seguir impartiendo clases en la escuela, colegio o universidad? Los análisis fueron realizados empleando el procedimiento de ponderación establecido por el INEI. Resultados: La pregunta sobre conocimiento mejor respondida fue la referida al uso del condón para disminuir el riesgo de contagio (86.5 por ciento), mientras que el 35.2 p respondió erróneamente que se puede contraer el VIH al compartir utensilios con una persona infectada...

Objective: To determine the association between the Peruvian women's knowledge about HIV and her attitudes towards the people with HIV, and the socio-demographic features. Methods: Secondary analysis of the Demographic and Family Health Survey (ENDES in espanish) 2011. The knowledge about HIV was measured with five questions: can the risk of contracting HIV be reduced by having only one sexual partner?, by using condom? A person who seems healthy, can have HIV? Can HIV be contracted by kisses and hugs?, by utensils? It was considered an adequate knowledge if the woman answered correctly the five questions (Guidelines on construction of core indicators for monitoring the political declaration of HIV/AIDS). The attitudes towards people with HIV was evaluated through six questions: if a child have HIV infection, should he or she be allowed to go to the school?; if a doctor have HIV infection, should he or she be allowed to continue working in a health center?; if a person with HIV need a surgery, should he or she be allowed to have the surgery?; would you buy vegetables from a seller with AIDS?; if a teacher have HIV infection, should he or she continue giving classes in the school, college or university? Every analysis was done using the weights established by the Statistics and Informatics National Institute (INEI). Results: The question about knowledge best answered was the one about using condom to reduce the risk of infection (86.5 percent), while 35.2 percent answered that HIV can be contracted by sharing utensils with a person infected. Only 38.9 percent answered correctly the five questions about knowledge. The best attitudes were observed in the scenario of a person with HIV who need a surgery and about the decision of firing an infected person, while the worst attitudes were observed about allowing a doctor with HIV to continue working and buying vegetables to a seller with AIDS...